"Cool" Changes under CMS Fee-for-Service's 5010 Implementation

CMS Fee-for-Service (FFS) is the government agency that is responsible for Claims under Medicare Part A and Part B.  They are currently making some really "cool" changes under the 5010 Project that Providers will be glad to hear about.  Something for Health Plans to consider, as they also implement 5010 by the mandated date of January 1, 2012.

1.  CMS FFS will replace their proprietary claims acknowledgement reports with the widely-used 277CA X12N standard format.  The 277CA is already used by most Health Plans to acknowledge the initial receipt of Claims and to communicate any initial status (such as errors).  This is good for Providers because it means they will receive the same format going forward from Health Plans and CMS FFS which makes claims acknowledgement management easier because it can now follow the same process.

2.  CMS FFS will generate their Claim Numbers up front when the Claim is received.  This is great news for Providers because it means they will be given the assigned Claim Numbers up front so that they can immediately use the number to inquire about the status of their Claim.

3.  CMS FFS will be able to receive paper attachments to electronic Claims.  A Provider can fill out a coversheet and fax the attachments to CMS.  CMS will systematically link the electronic claim to the attachment.  This eases the burden on CMS FFS and Providers because it means no extra time is spent looking for paper or proving that an attachment was mailed or faxed.

4. CMS FFS is going to be ready for 5010 by Jan 1, 2011!  That gives Providers and Secondary Payers ONE year to test with CMS FFS before the mandated compliance date.

How is Medicare Part B Fees calculated?

CMS updated it's fee schedule recently for the reimbursement rates it pay for Part B procedures.  The Factsheet that they put together is very informative.  It describes how CMS determines the reimbursement rate for a claim, in case you ever wanted to know!

Rates are frequently adjusted, usually annually.  With recent regulation, reimbursement rates had gone down which has Providers and Health Insurance Plans concerned.  The update this month increased the reimbursement by 2.2%.

What does Health Care Reform mean to me?

With the health care reform bill newly signed at the beginning of this year, many people are wondering how the federal health care reform bill will impact them.  I've heard stories that when Medicare was instituted that college students were hired to go door-to-door to communicate the message of what the program was all about.  Communication this time around will be equally as important as a lot of people are really confused about the reform.

Very simply, the new health care reform bill means that if you have happy with your insurance through your employer, you can keep it.  However, if don't have the opportunity to buy through an employer or want to purchase independently, you can goto a Health Insurance Exchange to purchase your insurance.  The Health Insurance Exchange will be available starting in 2014 or sooner, depending on the State in which you reside.  The benefit of the reform is that insurance will be more affordable to those where it is out of reach today due to age or health status; everyone is pooled together so the rates can be more affordable for an Individual.  The benefit of the Exchange is that it will provide consumers many product options where it is easy to compare and choose a health plan.  To see how an Exchange might evolve, take a look at healthcare.gov which is the federal version of what a State might offer to compare plans.  The health reform also has an Individual Mandate, where everyone must now carry health insurance or take a penalty; this is a highly debated topic within the reform.

The details of the regulation are still being ironed out.  Also, 20 States have joined the State of Florida to appeal some of the reform.  Therefore, the final landscape will shake out over time.  Some States have already started their paths to meeting the reform and the Exchange requirements.

text4baby - Mobile Health App

Today is a repeat of yesterday where I stumbled upon another very "cool" mobile health app.  This application is text4baby.  Simple tool where expecting and new mothers can sign up to receive weekly text message tips on their cell phone around the health of mother and baby.  Being a recently new mommy of two, I would have loved this application.  Those without this app would probably do what I did... Every week I would confusingly re-calculate how many weeks along I was and hunt through the motherhood book to find the section regarding my number of weeks.  text4baby is a great idea!

(Though I think the concept is cool, I have to be fair and say that I haven't tried it!)

GE Healthcare Morsel - Mobile App

Stumbled upon a "cool" healthly mobile application today.  It came up as an Ad link in my Google Email (gmail).  GE Healthcare has newly created a mobile app called Morsel.  Their tagline is "your daily step toward better health."  The purpose is to suggest small things that everyday people can easily do to improve their health.  For example, today's entry is "Try rice or almond milk instead of regular milk".  It gives the user the ability to say that they tried it, so you can see how many other people have done this; great motivator to try it when you know others are doing it.  It is still in it's infancy so not much functionality yet; the other cool feature is that you can suggest a "morsel".  In the recent past, I had mentioned to someone that I think it's hard to get healthy people to adopt to healthcare mobile technologies, but actually, I think I may be turning the corner on this.  I would use this app!

Prescription Safety

We found out from the doctor that my infant has an ear infection again. She seems to always get them so this is our third trip to the pharmacy in the last couple months. The doctor called in the prescription in the morning and I went to pick it up in the evening after work. My infant and I were there together, I was holding her on my hip because she's not walking yet. When we arrived the line was probably ten people deep, something that I've experienced before at this pharmacy. It was about fifteen minutes until we got to the front of the line for pick-up. I think someone should create a vending machine for frequently prescribed low-risk drugs and leave the personal interaction to the more complicated situations.

At the front of the line, I told the cashier my daughter's name and she couldn't find her prescription so then I had to wait for the ONE Pharmacist on duty. Another half an hour later, we find out that her prescription was flagged earlier by the prior Pharmacist on duty because the dosage prescribed by the doctor was double what is recommended. For someone like me who is curious about healthcare process and systems, this was interesting to me. I had not experienced this type of feedback before. The Pharmacist said it would probably be another half hour while she checks with my daughter's doctor. At this point, it was 45 minutes since we arrived to the pharmacy and my daughter was getting impatient so we left and I would come back later.

When I went back later to pick up the prescription, of course I had so many questions. How did the Pharmacist know it was double the dosage? Did the computer tell her that? I did ask the questions and the answer was, they have a manual process where they check the appropriateness for all prescription for children under one years old. They do have a system that checks the appropriateness of some prescriptions, but this did not fall into that category. The Pharmacist did get ahold of the doctor and confirmed the original dosage was incorrect and modified it. I was so happy that they identified this conflict since it wasn't safe for my baby. I was so happy and the Pharmacist too seemed beaming that she could help.

Bringing this post back to Technology. I was surprised that this wasn't caught by any system either at the Physician's end when writing the prescription or at the Pharmacy. Patient safety is critical and risky for health businesses if prescriptions are not appropriate for the patient. I am extremely grateful that through human review this error was found. However, this is a scenario that I think needs to be more protective to patients by the use of technology. We should be integrating tools like prescription screeners to improve patient safety.